Eating Disorders Don't Have One Look

by Ayala Lefkowitz

When you hear the words “eating disorder,” what do you picture? While many people picture a certain body type, eating disorders do not discriminate. People in all types of bodies can be struggling with an eating disorder, and the misconception that someone must be underweight to have a diagnosable eating disorder keeps many people from getting the treatment they need to recover.

Even once in treatment, many people struggle to accept that they need help because their body does not fit the stereotype of what an eating disorder “looks like.” They may believe they are not “sick enough” or worry that others will not take their struggles seriously. Comments from friends, family, or even healthcare providers can unintentionally reinforce these beliefs simply because their body does not “look” like someone with an eating disorder.

When someone in a bigger body is struggling with eating disorder thoughts and behaviors, those behaviors may initially be praised instead of recognized as warning signs. They may hear comments like, “Wow, look at your self-control,” while they are actually engaging in dangerous restrictive behaviors. They may be complimented for rapid or dramatic weight loss, reinforcing the illness rather than encouraging treatment.

In contrast, people in smaller bodies are often met with concern and referred for treatment much sooner after losing weight. People in smaller bodies face their own unique challenges as well. They may hear comments such as, “Wow, you’re so thin,” or, “It’s good to see you eating a piece of cake,” which can also reinforce disordered thoughts and create feelings of shame or pressure around food.

No matter someone’s body size, the warning signs of an eating disorder are the same. Things to look out for include changes in thoughts and behaviors around food, increasing body dissatisfaction, compulsive or excessive exercise, perfectionism, rigid food rules, and physical symptoms such as fatigue, dizziness, feeling cold, headaches, or gastrointestinal changes.

Only about 6% of people with eating disorders are underweight. If we continue to use weight as the measure for identifying eating disorders, the vast majority of people living with these illnesses will be overlooked. Learning to recognize the cognitive, behavioral, and emotional signs of an eating disorder allows people to receive help sooner, and early intervention consistently leads to better outcomes.

One of the most painful parts of working toward recovery in a bigger body can be the lack of validation and support. Research and clinical experience both show that social support plays an important role in recovery. Yet when someone is in a bigger body, their eating disorder may be less visible, leaving them with fewer people recognizing their struggle or offering help.

Even if someone opens up about what they are experiencing, they may not be believed

because their body does not match society’s expectations of what an eating disorder should look like. This lack of validation often feeds into the belief that they don't really have a problem, making it even harder to seek or stay engaged in treatment.

Because we never truly know what someone is struggling with, we should be thoughtful about the comments we make about bodies, weight, and food. A comment intended as a compliment can unintentionally reinforce an eating disorder or deepen someone’s pain. When in doubt, leave the comment out!

Another significant obstacle to treatment is the person’s own perception of their illness. Feeling “not sick enough” is one of the most common experiences among people with eating disorders. Many believe they only deserve treatment if they have obvious physical signs of illness, such as significant weight loss, abnormal lab work, unstable vital signs, or a missing menstrual cycle.

It is important to recognize that physical symptoms are only one piece of the puzzle. Eating disorders are mental illnesses with physical consequences, not simply physical illnesses. Someone can be medically stable while still experiencing severe psychological distress and engaging in dangerous eating disorder behaviors. If someone is struggling with food, exercise, or their relationship with their body, they deserve support and treatment regardless of what the scale, their labs, or their appearance may suggest.

The sooner we move away from judging eating disorders by appearance and instead focus on thoughts, behaviors, and distress, the more lives we can reach.

Recovery should never be determined by body size or whether someone appears “sick enough.” Every person deserves to be seen, believed, and offered support. By challenging outdated stereotypes and approaching conversations about food and bodies with greater care, we can create a world where more people receive the help they need before their illness becomes even more severe